1370例肝内胆管细胞癌肝切除术的疗效及预后因素分析  

Clinical efficacy and prognostic factors of liver resection for intrahepatic cholangiocarcinoma in 1 370 patients

作　　者：沈锋[1] 王葵[1] 阎振林[1] 李俊[1] 夏勇[1] 施乐华[1] 张小峰[1] 项红军[1] 吴孟超[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝外四科,上海200438

出　　处：《中华消化外科杂志》2016年第4期319-328,共10页Chinese Journal of Digestive Surgery

摘　　要：目的分析肝切除术治疗肝内胆管细胞癌（ICC）远期疗效以及影响患者早期肿瘤复发和预后的相关因素。方法采用回顾性队列研究方法。收集2005年1月至2012年12月第二军医大学东方肝胆外科医院收治的1370例ICC患者的临床病理资料。患者术前行实验室和影像学检查，依据术前检查结果制订手术方案。观察指标：（1）患者术前检查结果：肝功能、肿瘤标志物、影像学检查结果。（2）手术治疗情况：手术方式、手术时间、术中出血量、术中输血情况、术中肝门阻断情况、术后并发症、术后住院时间。（3）术后病理学检查情况：肿瘤分化程度、血管侵犯、淋巴结转移、局部侵犯、TNM分期。（4）患者随访结果：肿瘤复发情况、术后生存情况。（5）影响术后肿瘤早期复发的单因素和多因素分析。（6）影响患者术后预后的单因素和多因素分析。（7）列线图评分及亚组分析，依据患者的列线图评分对患者生存风险分层，取列线图评分的三分位数将患者分为低分组、中分组以及高分组3个亚组，并比较3组患者的临床病理特征和预后。采用门诊、电话和信件方式随访。术后前2年内每2-3个月随访1次，2年之后每3-6个月随访1次。随访内容包括病史采集和体格检查，CA19-9、CEA、AFP、肝功能、血常规，胸部X线片和腹部超声等检查。每6个月进行1次CT或MRI检查，若怀疑有复发转移可提前行该检查。复发的诊断主要依据影像学检查结果和临床表现。随访时间截至2014年12月15日。连续性变量以M（范围）表示，应用Shapiro-Wilk检验进行正态性检验，不符合正态分布时采用Mann-Whitney U检验进行组间比较，符合正态分布时采用t检验进行组间比较。分类变量采用，检验或Fisher检验。用寿命表法计算患者术后肿瘤复发率以及总体生存率，以Kaplan-Meier法绘制肿瘤复发和患者�Objective To investigate the long-term outcomes of liver resection in the treatment of 1 370 patients with intrahepatic cholangiocarcinoma （ICC） and the related factors affecting tumor recurrence and patients＇ prognosis. Methods The retrospective cohort study was adopted. The clinicopathological data of 1 370 patients with ICC who underwent liver resection at the Eastern Hepatobiliary Surgery Hospital between January 2005 and December 2012 were collected. Patients received laboratory and imaging examinations, and then surgical plan was determined according to the preoperative results. Observation indicators included （ 1 ） preoperative examinations results ： liver function, tumor markers and imaging examination, （2） surgical treatment ： surgical procedures, operation time, volume of intraoperative blood loss, intraoperative blood transfusion, hepatic inflow occlusion, postoperative complications and duration of hospital stay, （3） postoperative pathological examination： tumor differentiation, vascular invasion, lymph node metastasis, local invasion and TNM stage, （4） results of follow-up： tumor metastasis and postoperative survival. （5） There were univariate analysis and multivariate analysis affecting postoperative tumor early recurrence. （6） There were univariate analysis and multivariate analysis affecting postoperative patients＇ prognosis. （7） Patients＇ survival risk was stratified to 3 subgroups, namely, low score group, median score group and high score group, based on tertiles of their nomogram scores. The follow-up using outpatient examination, telephone interview and letters was performed once every 2-3 months within 2 years postoperatively and once every 3-6 months after 2 years postoperatively up to November 15, 2014. The follow-up included that data collection of medical history and physical examination, levels of CA19-9, carcinoembryonic antigen （CEA） and alpha-fetoprotein （AFP）, liver function, routine blood test, chest X-ray and abdominal ultrasou

关 键 词：胆道肿瘤 肝切除术 预后 

分 类 号：R735.8[医药卫生—肿瘤]